This therapy development study systematically introduces Methadone Anonymous (MA), a 12-step program, into conventional methadone maintenance treatment (MMT) in order to improve the outcome of rehabilitation. A number of problems are apparent in the care of MMT patients: high illicit drug use, lack of motivation for successful community integration, and HIV-risk behavior. These have shown relatively little improvement from the impact of program enhancements like traditional social services and pharmacologic adjuncts. Although the 12-Step model typically involves rejection of dependency-producing agents in treatment, our findings to date suggest that it can enhance the rehabilitation of methadone patients when it embodies the acceptance of methadone maintenance. This benefit can be understood on theoretical grounds on the basis of MA's peer support, voluntary affiliation, and spiritual orientation. However, the feasibility of this MA format has yet to be empirically demonstrated. This project is therefore framed as an R21 grant because it involves the introduction of an approach based on a theoretical model of treatment drawn from another field, namely, the AA maintenance-free approach. The study will proceed as a randomized group design, to include an MA Facilitation (MAF) treatment group (N = 96) and a comparison treatment-as-usual group (N = 96). The specific aims of this study are to: (1) prepare and evaluate an MAF manual for use by staff in the MAF condition; (2) assess the impact of MAF on outcome variables assessed at 6 months (e.g., illicit drug use, HIV risk behaviors); and (3) determine the impact of select patient characteristics (e.g., level of psychiatric distress, motivation) on change in MA attendance and illicit drug use among patients in the MAF condition. Consecutive admissions to the program will be randomly assigned to one of two treatment sites (standard methadone AT with MAF vs. standard MMT only). The development of the MA manual and results of this evaluation will provide pilot data for preparation of an RO1 proposal.